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1104532340
KEVIN A PHILLIPS
FAIRFIELD, CA
NPI
1104532340
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor Addiction (Substance Use Disorder)
Enumeration Date
2023-01-30
Last Update Date
2023-01-30
Business Address
KEVIN A PHILLIPS SUDRC
1225 TRAVIS BLVD STE H
FAIRFIELD, CA 94533-4839
Phone number: 707-399-9190
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Mailing Address
KEVIN A PHILLIPS SUDRC
609 JEFFERSON ST
FAIRFIELD, CA 94533-6293
Phone number: 707-399-9190
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